HOW PATIENTS ADAPT DIABETES SELF-CARE RECOMMENDATIONS IN EVERYDAY LIFE

BACKGROUND. Our study explored behavioral factors affecting what patie nts with type 2 diabetes do for self-care and why they do it. The find ings were used to develop clinical recommendations to improve interven tion strategies. METHODS. Interviewers, using open-ended questions, ex plored patients' own perceptions and assessments of self-care behavior s. The fifty-one subjects were self-identified Mexican Americans who h ad type 2 diabetes for at least 6 months, and had no major impairment as a result of this diabetes. Texts of patient interviews were analyze d by building and refining matrixes to display and compare central the mes regarding treatment strategies and their contexts. RESULTS. All pa tients were trying to control their diabetes, but none of them followe d recommendations completely. Instead, they adapted self-care behavior s to the exigencies of everyday life. Key factors influencing patients ' treatment choices were: (1) the belief in the power of modern medici ne; (2) the desire to act and feel ''normal''; (3) the desire to avoid physical symptoms; and (4) limited economic resources. CONCLUSIONS. A s patients apply treatment recommendations in the context of their eve ryday lives, they continually must make many small decisions affecting self-care behavior. The specific contexts of patients' lives, includi ng their economic, educational, and cultural circumstances, determine how the generalized principles of type 2 diabetes management are imple mented, Clinical strategies must be responsive to these circumstances in order to enable patients to make appropriate decisions when adaptin g their self-care behaviors to their own situations.